Objective To explore the characteristics of oxygen uptake efficiency (OUES) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and analyze the relationship between OUE and severity of disease.Methods Pulmonary function test,polysomnogram and cardiopulmonary exercise testing were performed in 35 patients with OSAHS and 25 age-matched healthy volunteers.Their successive breathing respiratory exchange parameters were collected and analyzed.And t and x2 tests were used for 2 sample comparison.Correlation analysis was performed by Pearson correlation test.Results Significant differences in peak VO2 and peak VO2 ％ pred existed between OSAHS and normal control groups [(18±4) vs.(28 ±6) L/min,P＜0.01;(68±14) vs.(84±16) ％,P＜0.01].Compared with normal control group [(2.3 ±0.5) L · min-1 · lg-1 ; (36 ±4) ml/L; (36 ±4) ml/L],OUES,OUEP and OUE@AT of OSAHS group [(1.8 ± 0.4) L · min-1 · lg-1 ; (31 ± 5) ml/L; (30 ± 5) ml/L] were significantly lower (t =3.78-4.49,all P ＜0.01).And OUES,OUEP and OUE@AT in OSAHS patients were correlated (r =0.53-0.67,all P ＜0.01) positively with exercise tolerance (peak VO2％ pred) while negatively with apnea hypopnea index (AHI) (r=-0.67--0.54,all P ＜0.01).Conclusion The oxygen uptake efficiency of patients with OSAHS is significantly reduced compared to that of normal subjects.And it is correlated negatively with severity of disease.

Objective This study aims to evaluate the initial results of a hybrid procedure for treating descending thoracic aortic disease that involves distal aortic arch.It also intends to report our initial experience in performing this procedure.Methods A total of 45 patients(35 males and 10 females) with descending thoracic aortic disease underwent a hybrid procedure,namely,thoracic endovascular aortic repair(TEVAR) combined with supra-arch branch vessel bypass,in our center from April 2009 to August 2014.Right axillary artery to left axillary artery bypass(n =20) or right axillary artery to left common carotid artery and left axillary artery bypass(n =25) were performed.The conditions of all patients were followed up from the 14th month to the 77th month postoperative[mean(38.0 ± 17.1) months].Mortality within 30 days,complications such as endoleak after the hybrid procedure,and stenosis or blockage of the bypass graft during the follow-up period were assessed.Results One case of death and one case of cerebral infarction were reported within 30 days.Two patients underwent open surgery beacuse of endoleak.And a newly formed intimal tear was observed in one patient and the patient underwent a second TEVAR during the follow-up period.Condusion Initial results suggest that the one-stage hybrid procedure is a suitable therapeutic option for thoracic aortic pathologies that involve distal aortic arch.However,this procedure is not recommended for type-B aortic dissection,in which a tear is located in the greater curvature or near the left subclavian artery,because of the high possibility of endoleak occurrence.

ObjectiveTo systematically review the efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) versus endoscopic sphincterotomy combined with large balloon dilation (ESBD) in the treatment of large common bile duct stones (≥10 mm). MethodsPubmed, Embase, Cochrane Library, CNKI, Wanfang Data, and VIP were searched for related articles published up to March 2020. Two reviewers independently performed article screening, data extraction, and quality assessment, and RevMan 5.3 software was used for statistical analysis. ResultsA total of 11 studies (6 randomized controlled trials and 5 non-randomized controlled trials) were included, with 1282 patients in total. The meta-analysis showed that in the 6 randomized controlled trials, there were no significant differences between the EPLBD group and the ESBD group in initial stone clearance rate (odds ratio ［OR］=0.71, 95% confidence interval ［CI］: 0.45-1.12, P=0.14), overall stone clearance rate (OR=1.39, 95%CI: 0.65-2.96, P=0.39), rate of use of mechanical lithotripsy (OR=1.19, 95%CI: 0.75-1.89, P=0.46), and incidence rate of early complications (OR=1.10, 95%CI: 0.60-2.03, P=075); in the 5 non-randomized controlled trials, there were no significant differences between the EPLBD group and the ESBD group in initial stone clearance rate (OR=0.64, 95%CI: 0.35-1.15, P=0.13), overall stone clearance rate (OR=0.46, 95%CI: 0.19-112, P=009), and incidence rate of early complications (OR=1.20, 95%CI: 0.65-2.21, P=0.56), but the EPLBD group had a significantly higher rate of use of mechanical lithotripsy than the ESBD group (OR=1.96, 95%CI: 1.26-3.05, P=0.003). ConclusionEPLBD and ESBD have similar efficacy and safety in the treatment of large common bile duct stones, while EPLBD may increase the risk of the use of mechanical lithotripsy. More high-quality randomized controlled trials are needed to confirm this conclusion.

Objective:To study the effectiveness and safety of perioperative lactated Ringer solution (LRS) in prevention and alleviation of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) under different fluid replacement regimens to arrive at the most precise quantitative fluid replacement regimen.Methods:Pubmed, Embase, Cochrane Library Database, Wanfang Database, CNKI, and VIP were searched from inception to February 2020. Randomized controlled trials on LRS in prevention and alleviation of PEP under different fluid replacement regimens were collected. The experiment group was actively rehydrated with LRS during the perioperative period, and the amount of rehydration was significantly higher than that of the control group. The control group was given standard dose of LRS or normal saline. Two researchers independently selected the articles based on predetermined inclusion and exclusion criteria, extracted the data, and evaluated the risk of bias. RevMan 5.3 software was used for statistical analysis.Results:Ten studies with 2 261 patients were included, with 1 140 patients in the experiment group, and 1 121 patients in the control group. Meta-analysis showed that when the experiment group was given LRS at a rate of 5.0 ml·kg -1·h -1 during the perioperative period for about 9 hours and compared with the control group, the incidence of PEP in the experiment group was significantly reduced ( OR=0.32, 95% CI: 0.21-0.48, P<0.05). The incidence of moderate to severe PEP was also significantly reduced ( OR=0.28, 95% CI: 0.09-0.84, P<0.05). There was no increase in the incidence of adverse reactions related to fluid replacement. However, there were no significant differences in the incidence of PEP, and in moderate to severe PEP between the two groups when LRS was given at a rate of 4.0~4.5 ml·kg -1·h -1 within 9 hours, and less than 4.0 ml·kg -1·h -1 within 24 hours of total rehydration time (all P>0.05). Conclusion:During the perioperative period, the current evidence showed that it is most reasonable to give the fluid replacement regimen with aggressive hydration using LRS at a rate of 5.0 ml·kg -1·h -1 in about 9 hours to prevent and alleviate PEP. This is recommended for clinical practice and is worthy of further future studies.

Objective To study the protective effect of stress-associated endoplasmic reticulum protein 1 (SERP1)on glucose and oxygen deprivation-induced injury in cardiomyocytes.Methods Gene expression was analyzed in the public database Gene Expression Omnibus(GEO)and screened for any difference in gene expression in myocardial tissues between the control group and the ischemiareperfusion group(IR group).Rat H9C2 cardiomyocytes were cultured and a myocardial cell injury model was established by oxygen glucose deprivation(OGD).The effect of SERP1 expression on cell viability,apoptosis and the endoplasmic reticulum stress pathway in cardiomyocytes were examined.Results Western blot results showed that the expression of SERP1 in myocardial tissues decreased in the IR group,compared with the control group(t =6.83,P =0.006).Oxygen and glucose deprivation induced decreased levels of SERP1 mRNA and protein expression in H9C2 cardiomyocytes in a timedependent manner (F =8.50 and 15.70,P =0.007 and 0.001).In addition,oxygen and glucose deprivation led to decreased cell viability and increased apoptosis,while exogenous addition of SERP1 had protective effects in H9C2 cardiomyocytes by promoting cell viability and reduced cell apoptosis.The lncRNA microarray and real-time PCR results showed that SERP1 could inhibit the expression of lncRNA CDKN2B-AS1 and further increase the phosphorylation of JAK2 and STAT3,leading to decreased expression of endoplasmic reticulum stress markers GRP78 and CHOP(all P＜ 0.05).Conclusions SERP1 can inhibit cardiomyocyte injury induced by glucose deprivation,and the underlying molecular mechanism may be related to the inhibition of CDKN2B-AS1 expression,promotion of the JAK2/STAT3 signaling pathway,and suppression of endoplasmic reticulum stress.

Objective To study the protective effect of chemokine C-C motif ligand 6 (CCL6) on glucose-oxygen deprivation induced injury in cardiomyocytes and its possible molecular mechanism.Methods Gene expression was analyzed in the public database Gene Expression Omnibus (GEO) database and gene expression of analyzed for myocardial tissue was analyzed gene expression in the sham group and the ischemia-reperfusion group (IR group).Rat H9C2 cardiomyocytes were cultured in vitro,and myocardial cell injury model was established by oxygen glucose deprivation (OGD).Cell viability was detected by MTT assay;apoptosis was determined by Annex V/PI double staining;the expression of related genes was detected by real-time PCR and Western blot.Results Compared with the sham group,transcriptome analysis and real-time PCR showed that the expression of CCL6 in the myocardial tissue of the IR group was significantly decreased (P＜0.01).Oxygen glucose deprivation induced a decrease in CCL6 expression levels in H9C2 cardiomyocytes in a time-dependent manner.In addition,oxygen glucose deprivation leads to decreased cell viability and increased apoptosis;while addition of CCL6 promotes cell viability and reduces apoptosis.The IncRNA microarray and real-time PCR showed that CCL6 treatment of cardiomyocytes resulted in a significant decrease in the expression of hicRNA IGF2-AS and further increased the phosphorylation of Akt and GSK-3β.Conclusion CCL6 can inhibit cardiomyocyte injury induced by glucose deprivation,and its molecular mechanism may be related to inhibition of IGF2-AS and enhancement of Akt/GSK-3β signaling pathway.

Objective:To explore the effects of feedback teaching based on dynamic cases on teaching quality of practice nurses in the department of neurosurgery.Methods:A total of 69 practice nurses from the Department of Neurosurgery in the First Affiliated Hospital of Nanjing Medical University were enrolled as the research subjects between January 2019 and August 2020, of which 33 practice nurses between January and October 2019 were selected as the control group and the other 36 practice nurses between November 2019 and August 2020 were selected as the observation group. The control group used routine teaching, while the observation group adopted feedback teaching based on dynamic cases. The assessment scores, practice effect, nursing job satisfaction, and the incidence of nursing errors after teaching were compared between the two groups. SPSS 24.0 was used for Chi-square test and t-test. Results:After teaching, the scores of each assessment (teaching rounds, health education, specialist nursing operations, morning questions, basic operations, and theoretical assessment) in the observation group were significantly higher than those in the control group, and the scores of disease change recognition ability, independent work ability, communication ability and teamwork ability were significantly higher than those in the control group ( P<0.05). After 1 week, 2 weeks, 3 weeks and 4 weeks of teaching, the teaching satisfaction in the observation group was significantly higher than that in the control group ( P<0.05). The total incidence of nursing errors in the observation group 2.78%(1/36) was significantly lower than that in the control group 27.27(9/33)( P<0.05). Conclusion:Feedback teaching based on dynamic cases can effectively improve the teaching quality of practice nurses in the department of neurosurgery, improve nursing job satisfaction, and reduce the risk of nursing errors.

Objective:To explore the adjunctive diagnostic value of transcranial sonography (TCS) combined with olfactory test in early Parkinson′s disease (PD) and the clinical value of both in the cognitive function of PD patients.Methods:TCS and olfactory test were performed in 157 early PD patients(PD group) and 157 healthy controls(control group) in the Second Affiliated Hospital of Soochow University from January 2018 to January 2022. The differences in clinical characteristics, TCS, and olfactory test results between the two groups were analyzed. The values of TCS, olfactory test, and their combination in diagnosing early PD were evaluated using clinical diagnosis as the gold standard. The correlations of the midbrain area, the midbrain substantia nigra hyperechoic area, and the third ventricle width in TCS examination with the cognitive score were analyzed in the PD group. According to the olfactory test scores, 157 patients with early PD were divided into two groups: 110 cases of PD with olfactory dysfunction (PD-OD) and 47 cases of PD without olfactory dysfunction (PD-NOD). The differences in clinical scores and TCS results between the two groups were compared.Results:The midbrain substantia nigra hyperechoic area, substantia nigra hyperechoic positivity rate, third ventricle width, and olfactory dysfunction rate were higher in the PD group compared to the control group, while the midbrain area and olfactory test scores were lower than those in the control group (all P<0.001). The sensitivity and the coincidence rate of TCS combined with the olfactory test for early PD diagnosis (90.0%, 77.1%) were higher than those of TCS alone (60.0%, 71.3%) and olfactory test alone (70.1%, 72.3%), but the specificity (63.7%) was lower than that of both alone (82.8% for TCS and 75.2% for olfactory test), (all P<0.001). MoCA score, visual space and executive ability, memory, attention, and language were positively correlated with the area of the midbrain ( rs=0.38, 0.32, 0.27, 0.25, 0.23; all P<0.05) and negatively correlated with the width of the third ventricle ( rs=-0.39, -0.22, -0.39, -0.22, -0.32; all P<0.05), and orientation was negatively correlated only with the width of the third ventricle ( rs=-0.24, P<0.05). The MoCA score of PD-OD group[22(18, 25)] was lower than that of PD-NOD group[24(20, 26)]( P=0.040). Conclusions:The combination of TCS and olfactory test can enhance the sensitivity and diagnostic agreement rate for early PD diagnosis, providing some auxiliary value. The cognitive function of PD patients is positively correlated with the midbrain area and negatively correlated with the width of the third ventricle. The cognitive function of PD patients with olfactory dysfunction is lower than that of PD patients without olfactory dysfunction. TCS and olfactory test may help assess cognitive function in PD patients.

Objective This study aims to evaluate the results of one-stage ascending-to abdominal aortic bypass and aortic valve replacement for concomitant aortic coarctation with aortic valve pathology.Methods From June 2009 to March 2017,28 consecutive adult patients(23males and 5 females) with aortic coarctation combined with aortic valve pathology underwent one-stage ascending-to-abdominal aorta bypass and aortic valve replacement or a Bentall procedure.Age 19-59,mean age (33.6 ± 11.6) years;1 case of coronary heart disease and 12 cases of aortic root tumor.Results All patients successfully underwent the one-stage procedure.The mean aortic cross-clamp and cardiopulmonary bypass times were (71 ± 23) and (113 ±37) mins respectively.The average post-operative hospital stay was(15.9 ± 4.9) days and the average operation time was (5.2 ± 4.0)h.Systolic blood pressure decreased from (158 ± 36)mmHg(1 mmHg =0.133 kPa) pre-operatively to(121 ± 18)mmHg post-operatively.After the operation,follow-up 3-96 months,No deaths or significant gradients between the upper and lower extremities occurred during follow-up.Conclusion Ascending-to-abdominal aortic bypass and concomitant aortic valve procedures are a suitable therapeutic option for severe aortic coarctation combined with aortic valve pathology in adult patients.

Objective    To analyze the diagnosis and treatment of patients with ventricular septal defect complicated with infective endocarditis. Methods    We retrospectively analyzed the clinical data of 40 patients with ventricular septal defect complicated with infective endocarditis in our hospital from 2001 to 2016. There were 25 males and 15 females, aged 20-62 (39.92±11.16) years. They were divided into two groups according to the duration from admission to surgery: a group A (an early operation group whose surgery was performed within 7 days after admission) and a group B (a conventional treatment group with the duration from admission to surgery>7 days). Among them, there were 27 patients in the group A including 15 males and 12 females with an average age of 39.56±11.80 years, and 13 patients in the group B including 10 males and 3 females with an average age of 40.69±10.13 years. All patients were examined by echocardiogram and blood bacterial culture to investigate their etiology, echocardiogram results and treatment status. And the clinical data of the two groups were compared. Results    Two patients died before operation in the group B, one died of heart failure, and one cerebral infarction. No reoperation during hospitalization, cerebral infarction, thromboembolism or other complications occurred. The ventilation time in the group A was significantly shorter than that in the group B (18.00±14.85 h vs. 31.00±29.57 h, P=0.015). There was no statistical difference in the extracorporeal circulation time, myocardial block time, or postoperative hospital stay between the two groups (P>0.05). After discharge, the patients continued antibiotic therapy for 3-6 weeks. Patients were followed up for 12-127 (75.74±6.01) months, 1 died of malignant tumors in the group A, 1 developed atrial fibrillation and 1 developed cardiac insufficiency in the group B, and the rest of patients did not complain of obvious discomfort. There was no residual shunt, recurrence of infective endocarditis, reoperation, postoperative stroke or thromboembolism. Conclusion    Preoperative echocardio-graphy and blood bacteriological culture are helpful for the diagnosis and treatment of patients with ventricular septal defect complicated with infective endocarditis. Early surgery is safe and effective for these patients, and can improve the long-term survival rate.